Male Sexual Disorders

Even the best patient-physician relationship can be challenged by complex subjects such as sexual health. From the physician’s perspective, we may make unwitting and harmful assumptions about patients’ sex lives, assuming they have one partner, have a heterosexual relationship, or don’t hope for pregnancy. We may incorrectly assume older patients are no longer sexually active and stop asking about sexual health. We may think patients don’t want to talk about their sexual health or don’t have sexual problems to discuss. Clinicians who assume patients don’t want to talk about sexual health are probably wrong. Research suggests that patients not only want to have these discussions, they want their physicians to initiate them.¹

For patients, particularly men, the conversation may be even more difficult if there is a gender mismatch, a significant age gap, or the patient is worried he will be judged. Men report embarrassment about having sexual health issues and fear they are unable to be helped.²

This edition of FP Essentials addresses important topics in men’s sexual health. (This issue uses “men” and “male” to refer to people assigned male sex at birth who identify as men.) The authors of this edition show us that family physicians should be familiar with the management of these conditions and comfortable with these conversations about sexual health problems in men.

It is clear from the information in this edition that sexual health problems are common among men. Just how common depends on the exact problem. Section One covers infertility and low libido. It informs us that infertility affects up to 15% of heterosexual couples, and 5% to 8% of men experience hypoactive sexual desire disorder.^3–5 Section Two discusses evaluation and management of disorders of the penis. Up to 50% of men between ages 40 and 70 years experience erectile dysfunction.⁶ This section describes evaluation and management of this common condition and others such as phimosis.

Section Three covers disorders of ejaculation. In this section, readers will learn that about 5% of men experience premature ejaculation, and up to 4% experience delayed ejaculation.^7,8 Section Three also discusses conditions such as hematospermia and retrograde ejaculation. Section Four addresses sexually transmitted infections, the most common of which, human papillomavirus, affects 42.5 million people in the United States.⁹ Section Four additionally discusses diagnosis and management of long-standing and emerging sexually transmitted infections.

The need for knowledge and skills in the field of men’s sexual health is evident from the high prevalence of these many conditions. I hope this edition of FP Essentials helps you initiate conversations and provide better care for the patients in your practice.

Kate Rowland, MD, MS, FAAFP, Associate Medical Editor
Vice Chair of Education and Associate Professor,
Department of Family and Preventive Medicine
Rush University, Chicago, Illinois

Benjamin Silverberg, MD, MSc, FAAFP, FCUCM, is a clinical associate professor in the Division of Primary Care and Population Health in the Department of Medicine at Stanford University School of Medicine in California. His clinical work centers on all aspects of college health, with emphasis on sexual and mental health. Dr. Silverberg is president of the Mid-Atlantic College Health Association, chair of the Clinical Medicine Section of the American College Health Association, and chair of the board of the West Virginia Academy of Family Physicians. He was recently selected as coeditor for the Journal of American College Health. This is the third FP Essentials edition he has authored.

Michael Partin, MD, FAAFP, is an assistant professor in the Department of Family and Community Medicine at Penn State Health Milton S. Hershey Medical Center (MSHMC). He serves as program director for the family medicine residency at Penn State Health MSHMC. Dr. Partin is the faculty lead for development and implementation of the quality improvement curriculum at the residency. He has mentored medical students and residents through various research projects and is passionate about teaching in the clinical setting.

Roland Newman, DO, is an assistant professor in the Department of Family and Community Medicine at Penn State Health MSHMC, with focuses on medical education and health systems management. Dr. Newman has a diverse background in family medicine, with experience in private practice and health systems administration. He previously served as chair of the Department of Family and Community Medicine at Penn State Health St. Joseph Medical Center. He is currently an associate program director at the family medicine residency at Penn State Health MSHMC. Dr. Newman assists in curriculum development, mentors residents, and facilitates resident-driven quality improvement initiatives.

Roderick Clark, MD, FRCSC, is an assistant professor and vice chair of education in the Department of Urology at Penn State Health MHSMC. He is also active in medical student and resident education at Penn State College of Medicine in Hershey, Pennsylvania. His published works include numerous book chapters and peer-reviewed articles in urologic research, and his clinical practice includes caring for patients experiencing primary and secondary sexual disorders.

Disclosure: It is the policy of the AAFP that all individuals in a position to control CME content disclose any relationships with ineligible companies upon nomination/invitation of participation. Disclosure documents are reviewed for potential relevant financial relationships. If relevant financial relationships are identified, mitigation strategies are agreed to prior to confirmation of participation. Only those participants who had no relevant financial relationships or who agreed to an identified mitigation process prior to their participation were involved in this CME activity. All individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.

Acknowledgment: The authors would like to thank Matthew Goldinger, APRN, and Luke O’Connor, DO, for feedback on early drafts. Dr. Silverberg would also like to acknowledge additional research support provided by West Virginia University during preparation of the manuscript.

• Define infertility and the factors associated with it in men.
• Evaluate male patients with infertility.
• Explain the causes of erectile dysfunction and other penile disorders.
• Manage common causes of erectile dysfunction.
• Identify common ejaculatory disorders.
• Describe the pathophysiology and evaluation of ejaculatory disorders.
• Evaluate male patients with genital or skin manifestations of sexually transmitted infections.
• Treat common sexually transmitted infections in male patients.